Shu Zekai, Zeng Ziyi, Yu Bingqi, Huang Shuang, Hua Yonghong, Jin Ting, Tao Changjuan, Wang Lei, Cao Caineng, Xu Zumin, Jin Qifeng, Jiang Feng, Feng Xinglai, Piao Yongfeng, Huang Jing, Chen Jia, Shen Wei, Chen Xiaozhong, Wu Hui, Wang Xiushen, Qiu Rongliang, Lu Lixia, Chen Yuanyuan
Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.
Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.
Front Oncol. 2020 Nov 6;10:594687. doi: 10.3389/fonc.2020.594687. eCollection 2020.
Malnutrition is a concern in patients with nasopharyngeal carcinoma (NPC) during chemoradiotherapy (CRT)/radiotherapy (RT), which is considered to be related with radiation-induced oral mucositis (ROM). The study aimed to evaluate the nutritional status of NPC patients during RT and investigate its association with ROM.
A prospective study was conducted in NPC patients. Patients were divided into three subgroups (mild, moderate, and severe groups) based on the duration of severe ROM (≥ grade 3). Body weight, body mass index (BMI), albumin, prealbumin, NRS2002, and ROM grade were assessed on a weekly basis before and during CRT/RT. The statistical analysis was performed in the overall group and between three subgroups.
A total of 176 patients were included. In the overall group, body weight and BMI kept decreasing since week 1 of RT, and NRS2002 score and ROM grade increased (p < 0.001). NRS2002 score and prealbumin levels were significantly different between each subgroup (p ≤ 0.046). Significant differences were observed in the proportion of patients receiving enteral nutrition, duration of parenteral nutrition, and total calories provided by nutritional support among three subgroups (p = 0.045-0.001).
Malnutrition occurred early in NPC patients and worsened continuously during RT. ROM was strongly associated with nutritional status. Nutritional support should be provided at the start of RT, especially in patients at high-risk of severe ROM.
营养不良是鼻咽癌（NPC）患者在放化疗（CRT）/放疗（RT）期间的一个问题，被认为与放射性口腔黏膜炎（ROM）有关。本研究旨在评估NPC患者放疗期间的营养状况，并调查其与ROM的关联。
对NPC患者进行了一项前瞻性研究。根据严重ROM（≥3级）的持续时间，将患者分为三个亚组（轻度、中度和重度组）。在CRT/RT之前和期间，每周评估体重、体重指数（BMI）、白蛋白、前白蛋白、NRS2002和ROM分级。在总体组和三个亚组之间进行统计分析。
共纳入176例患者。在总体组中，自放疗第1周起体重和BMI持续下降，NRS2002评分和ROM分级升高（p<0.001）。各亚组之间NRS2002评分和前白蛋白水平存在显著差异（p≤0.046）。三个亚组在接受肠内营养的患者比例、肠外营养持续时间以及营养支持提供的总热量方面存在显著差异（p=0.045-0.001）。
NPC患者早期出现营养不良，放疗期间持续恶化。ROM与营养状况密切相关。应在放疗开始时提供营养支持，尤其是重度ROM高危患者。
